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District of Columbia Advance Directive
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District of Columbia Advance Directive

How a D.C. advance directive works: the health care power of attorney, the living will declaration, who may witness each, and the MOST form.

By Settled Editorial

In the District of Columbia, an advance directive is usually two documents, each with its own signing rules. A durable power of attorney for health care names the person who makes medical decisions for you if you cannot (D.C. Code § 21-2205). A declaration, the District's living will, tells doctors to withhold or withdraw life-sustaining procedures if two physicians certify a terminal condition (D.C. Code § 7-622). Both need two adult witnesses, and the living will's witness rules are much stricter.

Use this page as a planning map, not as a finished form. It pairs with the D.C. power of attorney guide, which covers money and property, and with D.C. estate planning basics, which puts every incapacity and estate document in order. For the rest of the District's estate and probate pages, start at the District of Columbia directory.

The Two Documents D.C. Law Provides

D.C. law has no single document called an "advance directive." Two separate parts of the D.C. Code each create one instrument, and a third creates a medical order.

DocumentWhat it doesGoverning law
Durable power of attorney for health careNames an "attorney in fact" (your health care agent) to make medical decisions once you are certified incapableD.C. Code §§ 21-2201 to 21-2213
Declaration (living will)Directs that life-sustaining procedures be withheld or withdrawn in a certified terminal conditionD.C. Code §§ 7-621 to 7-630
MOST formA clinician's portable medical orders for a patient near the end of lifeD.C. Code §§ 21-2221.01 ff.

The health care power of attorney is the broader tool. Your agent can grant, refuse, or withdraw consent to any treatment, review your records, get the information a decision needs, pick and discharge doctors, and decide on admission to or discharge from a facility, subject to any limits you write in (D.C. Code § 21-2206). The declaration covers one situation only: a terminal condition where life-sustaining procedures would serve only to postpone death (D.C. Code § 7-621). Many people sign both.

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How to Sign a Health Care Power of Attorney

Any competent adult may name, in writing, a person to make health care decisions if the adult becomes unable to make or communicate a choice because of a mental disability (D.C. Code § 21-2205). The document must:

  • Say that you intend your agent to make health care decisions for you.
  • Carry durability language identical or close in meaning to "This power of attorney shall not be affected by the subsequent incapacity of the principal." or "This power of attorney becomes effective upon the incapacity of the principal."
  • Be dated and signed by you and by two adult witnesses who affirm that you were of sound mind and free from duress when you signed.

Two witness rules come from the same section:

  • Neither witness may be you, your health care provider, or an employee of your health care provider.
  • At least one of the two must not be related to you by blood, marriage, or adoption, and must not be entitled to any part of your estate under a current will or by operation of law.

Section 21-2205 does not list your agent as a barred witness, but the sample form in § 21-2207 has each witness declare, "I am not the person appointed as the attorney in fact by this document." Keeping your agent off the witness lines follows the District's own form. The statute calls for two witnesses and says nothing about a notary. Your financial power of attorney follows different rules: under the District's Uniform Power of Attorney Act it must be acknowledged before a notary public, which the D.C. power of attorney guide explains.

You do not have to use the sample form. Any written form that meets § 21-2205 works. The sample names an attorney in fact plus up to two backups in order, and it leaves space for your directions on life-prolonging care and for special provisions and limits (D.C. Code § 21-2207).

Two more rules protect you. No health care provider may make signing one a condition of treatment or admission. After you have spent at least 48 hours in a health care facility, a provider may ask you to sign one, but the provider may not be named as your agent (D.C. Code § 21-2209). A health care power of attorney validly signed in another jurisdiction under similar law counts as one in D.C. (D.C. Code § 21-2202).

How to Sign a Living Will Declaration

Anyone 18 or older may sign a declaration. It must be in writing, signed by you (or by another person in your presence at your express direction), dated, and signed in the presence of two or more witnesses who are at least 18 (D.C. Code § 7-622). The declaration must follow the form printed in § 7-622(c) in substance, and you may add other specific directions that fit the statute.

Here is the part that trips people up. Every witness to a declaration must meet all of these rules. A witness may not be:

  • The person who signed the declaration for you at your direction.
  • Related to you by blood, marriage, or domestic partnership.
  • Entitled to any part of your estate under D.C. intestate succession law or under any will or codicil you signed.
  • Directly financially responsible for your medical care.
  • Your attending physician, an employee of that physician, or an employee of the health facility where you are a patient.

A further rule applies in a nursing setting. If you are a patient in an intermediate care or skilled care facility when you sign, the declaration has no effect unless one of the two witnesses is a patient advocate or ombudsman, who must meet the same witness rules (D.C. Code § 7-623).

Once signed, it is your job to tell your attending physician that the declaration exists. A physician who receives it must put it, or a copy, in your medical record (D.C. Code § 7-622).

Witness rules side by side

RuleHealth care power of attorney (§ 21-2205)Declaration (§ 7-622)
Number of witnesses2 adults2 or more, each at least 18
RelativesAt least 1 witness must be unrelatedNo witness may be a relative or domestic partner
Heirs and will beneficiariesAt least 1 witness must not inheritNo witness may inherit
Your health care provider or its employeeBarredAttending physician, that physician's employee, and your facility's employees barred
Nursing facility patientNo added rule1 witness must be a patient advocate or ombudsman (§ 7-623)

If you sign both documents at one sitting, choose two witnesses who pass the declaration's stricter test. They will satisfy the power of attorney rules too, as long as neither is your health care provider or its employee.

When Each Document Takes Effect

Nothing changes the day you sign. Every adult is presumed capable of making health care decisions until certified otherwise, and a hospital stay for mental illness, an intellectual disability diagnosis, or a guardianship does not by itself show incapacity (D.C. Code § 21-2203).

Your agent's power starts on certification. Two professionals licensed in the District, one a physician and one a qualified psychologist or psychiatrist, must certify that you cannot make a health care decision. At least one of them must examine you within 1 day before certifying, and both must give an opinion on the cause, nature, extent, and probable duration of the incapacity in writing in your patient-care records (D.C. Code § 21-2204). That certification covers health care decisions only and is not a finding of incompetency for any other purpose. Even then, your agent may not make a decision you are still able to make yourself (D.C. Code § 21-2206).

Your declaration starts on a terminal diagnosis. Two physicians who personally examined you, one of them your attending physician, must certify in writing that you have a terminal condition (D.C. Code § 7-621). The attending physician must then tell you about the condition and note that in your record, unless you cannot understand the news, in which case the declaration applies at once on certification (D.C. Code § 7-625). Your own wishes at the time always override the declaration (D.C. Code § 7-626). Medication and procedures for comfort or pain relief fall outside "life-sustaining procedures," so a declaration never stops comfort care.

Your agent must follow the wishes you wrote in the document. When those wishes are unknown and cannot be found out, the agent acts on a good-faith belief about your best interests (D.C. Code § 21-2206).

Who Decides If You Have No Health Care Agent

Without a health care power of attorney, and once your incapacity is certified under § 21-2204, D.C. law hands the decision to the first available, capable, and willing person on this list (D.C. Code § 21-2210):

PriorityWho can decide
1A court-appointed guardian or conservator, within the scope of the appointment
1AA court-appointed intellectual disability advocate, within the scope of the appointment
2Your spouse or domestic partner
3An adult child
4A parent
5An adult sibling
5AA religious superior, if you belong to a religious order or are a diocesan priest
5BA close friend who has shown care and concern and kept regular contact with you
6Your nearest living relative

A few rules shape how the list works:

  • The surrogate decides on your known wishes or, if those cannot be found out, on a good-faith belief about your best interests.
  • At least one witness must be present whenever a family member, religious superior, or friend grants, refuses, or withdraws consent for you.
  • The order is a rebuttable presumption. A lower-ranked person who better knows your wishes can displace a higher-ranked one, and anyone on the list may challenge a higher-ranked person's decision in the Superior Court.
  • A close friend who is treating you, or who owns, runs, or works for your treating provider, cannot act.
  • A surrogate under this list may not consent to an abortion, sterilization, psycho-surgery, convulsive therapy, or a behavior modification program involving aversive stimuli without a court's approval (D.C. Code § 21-2211).

If no one on the list is available, the provider or any interested person may ask the Superior Court to appoint a guardian. The D.C. guardianship guide explains what that court process involves and what happens when no directive exists. Naming your own agent keeps the choice with you.

Changing or Revoking Your Documents

Neither statute sets an expiration date, so each document lasts until you revoke it.

Health care power of attorney. While you still have the capacity to make one, you can revoke your agent's appointment by telling the agent, orally or in writing, or revoke the agent's authority by telling your health care provider, orally or in writing. A provider who hears of a revocation must note it in your records and make a reasonable effort to tell your agent (D.C. Code § 21-2208). A new valid health care power of attorney revokes an earlier one unless it says otherwise.

Divorce matters here. Unless your document says otherwise, the dissolution, annulment, or termination of your marriage or domestic partnership after you signed automatically revokes your former spouse's or partner's appointment as agent. If you later remarry that person or re-enter the partnership, the appointment revives.

Declaration. You can revoke it at any time, whatever your mental state, in three ways (D.C. Code § 7-624):

  1. Destroy or deface it, or have someone do so in your presence at your direction.
  2. Sign and date a written revocation.
  3. Say you revoke it in front of a witness aged 18 or older, who signs and dates a writing confirming what you said.

A written or spoken revocation takes effect only once it reaches your attending physician, who records the time and date. After any change, give fresh copies to your agent and your doctors.

The MOST Form and Emergency Care

The Medical Orders for Scope of Treatment form is a set of portable medical orders on a form issued by the D.C. Department of Health (D.C. Code § 21-2221.01). It is meant for a patient whom a clinician has found to be approaching the end stage of a serious, life-limiting illness or frailty, with a life expectancy of 12 months or less.

  • Only a treating physician or advanced practice nurse may complete it, following your instructions or those of your authorized representative, and you or that representative sign it (D.C. Code § 21-2221.05).
  • No one may require you to complete one.
  • It travels with you between facilities and is reviewed at least once a year, after a major change in your condition, or on request.
  • You or your representative may revoke it at any time by telling the clinician who issued it or the treating EMS crew (D.C. Code § 21-2221.06).

If a MOST form and a health care power of attorney give conflicting directions, the more recently signed document controls (D.C. Code § 21-2221.10). The older EMS "comfort care order" sections are repealed, so the MOST form is the District's current portable order.

A Simple Planning Sequence

Use this order as a checklist, then confirm the details with a D.C. attorney or your clinician:

  1. Choose your health care agent and up to two backups, and ask each of them first.
  2. Write down the care you do and do not want, including any limits on your agent.
  3. Decide whether you also want a declaration for a terminal condition.
  4. Line up two adult witnesses who are not relatives, heirs, your doctors, or your facility's staff, so they qualify for both documents. Add a patient advocate or ombudsman if you live in a nursing facility.
  5. Sign and date, then give copies to your agent and your attending physician so the declaration lands in your medical record.
  6. If you face a serious illness, ask your clinician about a MOST form.
  7. Review everything after a divorce, a move, or a change in health.

Pair these documents with the rest of your plan. The D.C. power of attorney guide covers who manages your money if you cannot, and the planning checklist in D.C. estate planning basics covers wills, trusts, and beneficiary designations.

This guide is general information about advance directives in the District of Columbia. Confirm anything that affects your situation with a licensed D.C. attorney or your health care provider before you sign or rely on one of these documents.

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Information current as of October 5, 2026

Settled Estate is not a law firm, and this content is for informational purposes only and does not constitute legal advice. Probate laws and procedures in District of Columbia can change. Consult with a qualified attorney for advice specific to your situation. Full disclaimer.

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